A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block

Kaur, Manbir; Kaur, Rupinder; Kaur, Sarvjeet; Baghla, Naresh; Bansal, Aradhna; Kalia, Akshay; Kumar, Sushant; Lall, A.

doi:10.4103/aer.aer_64_18

Cited by 10 publications

(14 citation statements)

References 9 publications

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“…The incidence of bradycardia and hypotension was described in 28 studies [ 23 , 34 – 37 , 39 – 42 , 45 , 47 , 48 , 51 – 53 , 58 , 61 , 63 , 64 , 66 , 67 , 69 , 78 – 80 , 83 – 85 ] and 26 studies [ 23 , 34 – 36 , 39 – 42 , 45 – 48 , 51 – 53 , 58 , 63 , 64 , 66 , 67 , 69 , 78 – 80 , 84 , 85 ] respectively. Pooled analysis showed that perineural DEX>60 μg increased the risk of bradycardia (risk difference [RD]: 0.16, 95% CI: 0.06 to 0.26, I 2 = 97%, P = 0.002) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Cai

Fan

Feng³

et al. 2021

BMC Anesthesiol

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Background and Objectives Peripheral injection of dexmedetomidine (DEX) has been widely used in regional anesthesia to prolong the duration of analgesia. However, the optimal perineural dose of DEX is still uncertain. It is important to elucidate this characteristic because DEX may cause dose-dependent complications. The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery. Method A search strategy was created to identify suitable randomized clinical trials (RCTs) in Embase, PubMed and The Cochrane Library from inception date to Jan, 2021. All adult patients undergoing upper limb surgery under BPB were eligible. The RCTs comparing DEX as an adjuvant to local anesthetic (LA) with LA alone for BPB were included. The primary outcome was duration of analgesia for perineural DEX. Secondary outcomes included visual analog scale (VAS) in 12 and 24 h, consumption of analgesics in 24 h, and adverse events. Results Fifty-seven RCTs, including 3332 patients, were identified. The subgroup analyses and regression analyses revealed that perineural DEX dose of 30-50 μg is an appropriate dosage. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of analgesia duration with less than and more than 60 μg doses was 220.31 (153.13–287.48) minutes and 68.01 (36.37–99.66) minutes, respectively. With long-acting LAs, the mean differences (95% CI) with less than and more than 60 μg doses were 332.45 (288.43–376.48) minutes and 284.85 (220.31–349.39) minutes. Conclusion 30-50 μg DEX as adjuvant can provides a longer analgesic time compared to LA alone and it did not increase the risk of bradycardia and hypotension.

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Section: Resultsmentioning

confidence: 99%

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Cai

Fan

Feng³

et al. 2021

BMC Anesthesiol

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“…A total of 605 articles were excluded as they were not relevant to the review. Twenty-four articles were selected for full-text review of which 12 RCTs fulfilled the inclusion criteria [ 19 – 30 ]. A total of 12 studies were excluded with reasons (2 studies were not RCTs, 4 studies had no control group, and 6 studies were not on fentanyl).…”

Section: Resultsmentioning

confidence: 99%

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

Song

Tan

Chen

et al. 2022

Pain Research and Management

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Objective. To assess if the addition of fentanyl to brachial plexus block has an impact on anesthetic outcomes and complication rates in patients undergoing upper extremity surgeries. Methods. We explore the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for all randomized controlled trials (RCTs) comparing adjuvant fentanyl with placebo/no drug for patients undergoing upper extremity surgery under brachial plexus block. Outcomes assessed were onset, duration of sensory and motor anesthesia, complications, and postoperative analgesia scores. Meta-analysis was conducted utilizing a random-effects model. The risk of bias was assessed using the Cochrane Collaboration’s risk of bias assessment tool 2. Certainty of evidence was assessed using GRADE. Subgroup analysis was conducted depending upon the approach of brachial plexus block and type of local anesthetic. Results. Twelve RCTs with 660 patients were included. Addition of fentanyl had no effect on onset of sensory anesthesia (11 studies; MD: 0.48; 95% CI: −1.81, 0.85; I2 = 96%; p = 0.48 ) but significantly shortened onset of motor anesthesia (8 studies; MD: −2.36; 95% CI: −3.99, −0.74; I2 = 96%; p = 0.48 ). Duration of sensory anesthesia (9 studies; MD: 82.81; 95% CI: 41.81, 123.81; I2 = 99%; p < 0.0001 ) and motor anesthesia (7 studies; MD: 93.41; 95% CI: 42.35, 144.46; I2 = 99%; p = 0.0003 ) was significantly increased with addition of fentanyl. The certainty of evidence-based on GRADE was deemed to be moderate for both onset and duration of anesthesia. The incidence of overall complications (nausea/vomiting and pruritis) was significantly higher in the fentanyl group (7 studies; OR: 2.14; 95% CI: 1.04, 4.40; I2 = 8%; p = 0.04 ) but with low certainty of evidence. Conclusions. Adjuvant fentanyl with brachial plexus block improves the onset of motor anesthesia but not sensory anesthesia. The duration of both sensory and motor anesthesia is significantly prolonged with fentanyl by around 83–93 minutes. However, clinicians should be aware that complications such as nausea/vomiting and pruritis are increased twofold with the addition of the drug. Current evidence is limited risk of bias in the RCTs and high heterogeneity in the meta-analyses.

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“…They concluded that addition of 0.75 μg/kg dexmedetomidine to 0.5% levobupivacaine for supraclavicular plexus block shortens sensory and motor block onset time and extends sensory block, motor block, and analgesia duration. Kaur M et al [8] evaluated and compared the effect of dexmedetomidine versus fentanyl as an adjuvant with levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. This study design was a prospective, randomized, double-blind controlled study.…”

Section: Discussionmentioning

confidence: 99%

A prospective observational study to compare the effectiveness of bupivacaine versus levobupivacaine in supraclavicular brachial plexus block

Santosh¹,

Sharma²,

Gogna³

2021

Int. J. Med. Anesthesiology

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Background: Dexmedetomidine produces manageable hypotension and bradycardia, but the striking feature of this drug is the lack of opioid-related side effects such as respiratory depression, pruritus, nausea and vomiting. Addition of dexmedetomidine to local anaesthetic drugs during peripheral nerve blocks may also prove beneficial for surgical patients. Hence, the present study was performed to compare the effectiveness of bupivacaine and levobupivacaine for supraclavicular brachial plexus block in upper limb surgeries. Materials and Methods: The present study was conducted in the Department of Anesthesia of MGM Medical College, Navi Mumbai. The ethical clearance for the study was approved from the ethical committee of the hospital. The study was conducted on 100 patients of ASA I & II status in the age group of 18-60 years given brachial plexus block by supraclavicular approach for various upper limb surgeries, after receiving institutional ethics committee approval. Results: Levobupivacaine had a faster onset & longer duration of both sensory and motor blockade as compared to racemic bupivacaine. The hemodynamic profile of both drugs was similar and no adverse effect was found with either drug. Conclusion:We conclude that in peripheral nerve blocks where large volumes of local anaesthetic is required, levobupivacaine could be a suitable choice as it is known to have less toxic potential.

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A study to compare the analgesic efficacy of dexmedetomidine and fentanyl as adjuvants to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block

Cited by 10 publications

References 9 publications

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

A prospective observational study to compare the effectiveness of bupivacaine versus levobupivacaine in supraclavicular brachial plexus block

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